Presenters :

2. Presenters: Deana Buck, Program Group Leader Partnership for People with Disabilities, VCU Ashley Everette, Early Childhood Mental Health Consultant ChildSavers Mickie McInnis Include Me, Early Childhood Program Consultant Kathleen Lynch, Senior Research Associate Partnership for People with Disabilities, VCU

3. Background and Need for Project • Project Hugs – one of 6 Social-Emotional Pilot projects funded by VDSS • Administered by ChildSavers • Overall goals: • Improve child care provider access to resources • Increate capacity and competence of child care providers to address social, emotional, and behavioral needs of infants and toddlers

5. Background and Need for Project • Caregivers of infants and toddlers wanted training and support • Some infants and toddlers needed support to address challenging behaviors and mental health needs • Agencies/providers had history of collaboration • ChildSavers • United Way of Greater Richmond and Petersburg • Partnership for People with Disabilities • City of Richmond, EC Initiative

6. Early Childhood Mental Health Consultation Ashley Everette, M.A. Early Childhood Mental Health Consultant ChildSavers

7. The Case for Mental Health Consultation in Early Childhood Settings • Young children are being expelled from child care at 3 times the rate of children expelled from K-12. (Gilliam, 2005) • Child care providers continue to list coping with challenging behaviors as their number one need for additional training and support (Center for Evidence-Based Practices, 2005). Greater Richmond Area • In the greater Richmond area, few services existed to support the mental health of infants and toddlers. • 2010 needs assessment indicated that approximately 20-25% of child care programs responding had children ages birth to 3 who left care because of difficult behaviors .

8. What is Early Childhood Mental Health Consultation? • Problem-solving and capacity-building intervention implemented within early childhood settings. • Collaborative and reflective relationship with ECE staff and family members. • Promotes social and emotional development and seeks to reduce challenging behaviors • Relationship based • Always supporting the adult-child relationships vs. focusing solely on the child

9. Help Us Grow Strong (HUGS) Early Childhood Mental Health Consultation 2010 Project Implementation • ChildSavers served as lead agency • 2 Mental health consultants (MHC) hired with Master’s level degrees in mental health related field. • Contracted Doug Davies, LCSW, Project HUGS expert consultant on early ECMHC Service Implementation: • Children 0-36 months exhibiting behavioral concerns in early child care settings; • Free consultation services to ECE providers and parents/caregivers. • Child care centers and home-based setting located in Richmond City and designated zip codes within Henrico and Chesterfield County.

10. MH Consultant Training and Support • Specialized training in Infant Mental Health • Dr. Doug Davies, Project HUGS expert consultant on early ECMHC • Quarterly Onsite visits and training, and monthly phone consultations . • Specialized training in Infant mental health made available to other Richmond area clinicians, specialists, and mentors. • Ongoing support • Weekly Clinical Supervision

11. HUGS Goals To build the capacity of families and ECE staff to successfully nurture the social-emotional development of all children in their care, including those exhibiting challenging behaviors, to prevent expulsion as well as prevent, identify, and reduce the impact of mental health problems among children and their families.

12. HUGS Approach to Service Delivery • Embrace values that support relationship-building and high-quality service provision: • Collaborative • Family-Centered • Culturally Competent • Strengths-based • Individualize services/strategies • Promote consistency across home and classroom settings • Utilize hands-on, practical materials

13. Service Array • Child-Focused Consultation Focuses on a particular child with challenging behavior. • Program Consultation Focuses on enhancing the overall quality of an ECE program and/or assist the program in solving a specific issue that affects the mental health of more than one child, staff member, and/or family. Providing both types of consultation helps to ensure that services address the mental health needs of all children in an ECE program.

14. HUGS Consultation Process • Referral and Intake • Observation and Assessment • Meetings with team to develop Behavior Support Plan • Support to family and child care providers to implement plan • Referrals to outside services as needed • Conclusion of services *On average, services are provided for 3-6 months depending on the needs of the child and caregivers. The frequency of visits decreases as progress is noted.

15. Referral & Intake Who can refer children to HUGS ? • Child care providers • Parents/Guardians • Community agencies • ChildSavers • Early Intervention • VSQI Star Mentors Intake Process • Child must meet age and locality requirements • Parental/Guardian consent form • Parental Rights and Responsibilities • Child care center must sign Partnership Agreement

16. Why are children referred for HUGS Services? Children are referred for many reasons but most often for: • Aggression • Impulsivity • Non-compliance • Defiance • Tantrums 76% of referrals are boys • Destruction of property • Developmental Concerns • Communication challenges

17. Observation and Assessment Goal: Understand what the child is trying to communicate and to identify possible underlying reasons for challenging behavior • Information Gathering & Data Collection • Interviews with family and child care staff • Classroom observations • Home observations • Functional assessments • Standardized screening &Assessment tools: • ASQ-3 & ASQ: SE • DECA

18. Assessment : Areas of Exploration • Child’s experience with comfort trust, and interest in connect • Level of Developmental Mastery • What are the child’s areas of strengths? What developmental tasks challenge her? • Attention • Communication • Emotional Regulation, self-soothing • Impulse Control and Problem Solving • Flexibility

19. Areas of Exploration, Cont. • Constitutional Factors • Temperament • Language and Information Processing • Relational History • Family Functioning • Cultural Factors at home and school • Significant History • Trauma, Adoption, Attachment styles • Sleeping, Eating, Toileting behaviors • Gross and Fine motor Control • Trigger for Problematic Behavior • Early Care and Education Environment • Programmatic issues

20. Behavior Support Plan and Support • Collaborative process • Reflect on information gathered to created sound strategies that support child at home and school. • Goal Development • Agreed upon strategies to be implemented at home and school Support • Weekly-Biweekly support provided to family and providers until goals are met.

21. What Strategies do Consultants help caregivers to Use? Affect Regulation Strategies Tucker the Turtle Technique Sensory activities as soothers Sand table, water play, play dough, “Relaxation in a bottle” stress balls Use books to discuss feelings Calm down basket Yoga and Relaxation techniques deep breathing , blowing bubbles & Pinwheels Stress Balls Calm Down Basket

22. Strategies • Problem Solving • Modeling • Scripted Stories • Puppets • Individualizing Visuals • Positive Guidance-Feedback • Environmental Supports • Calming places and spaces: “Safe place”, • “Pillow house”, “Cozy area”, “peaceful • corner” • Utilizing feeling charts • Building Emotional literacy • - Naming , acknowledging, and validating feelings Scripted Stories Safe Place or Cozy area Individualized Visual supports

23. DIY Sensory Toys Water Beads

24. HUGS Accomplishments Since, April 2010: • 62 infants, toddlers, and preschoolers have received individual services • 71 families of young children received consultation services • 160 early childhood providers received specialized early childhood consultation supports. • 30 child care centers received consultation services on individual children *Only 1 child has been expelled due to behavior

25. Lessons Learned • Implement a strong service initiation process • Clarifying expectations • Need for ECMHC services for children 3-5years. • Services were most effective when families actively participated in services.

26. ChildSavers Early Childhood Mental Health Consultation Model 2012 • ChildSavers, Richmond, VA, committed to maintaining ECMHC services. • Provide child-centered mental health consultation • Expanded catchment area: Richmond City, all of Henrico and Chesterfield County • Expanded age range: 0-5years • Family Involvement is a requirement • Written agreements between HUGS and child care center or home provider • ECMHC Partnership Agreement

27. CSEFEL Training and Mentoring Mickie McInnis Early Childhood Program Consultant Partnership for People with Disabilities Virginia Commonwealth University

28. CESFEL Training • Schedule & Participant Selection • Modules 1, 2 • Participant Incentives • Module 3

29. CESFEL Program Mentoring • Resources and Plan (See Handout) • Training

30. CESFEL Training and Mentoring Lessons Learned

31. Project Evaluation Kathleen Bodisch Lynch Partnership for People with Disabilities Virginia Commonwealth University

32. Project HUGS Intended Outcomes Improved Access

33. Project HUGS Intended Outcomes Increased Capacity

34. Project HUGS Wiki

35. Evaluation Results Outcome 1: Improved access of child care providers to community resources

36. Strengthening Existing Resources

37. Greater Access to Resources ECMHC Consultation

38. Mental Health Clinicians Group MH Clinicians Ratings of Increased Knowledge Sustainability: Subcommittee of Statewide Infant/Toddler MH Endorsement Committee

39. Evaluation Results Outcome 2: Increased capacity of child care providers to recognize and address the social-emotional and behavioral development of infants and toddlers

40. Consultation to Child Care Centers Positive Feedback 98%

41. ~ In Their Own Words ~ “I learned a great deal of information, and our student has shown GREAT improvement, and this program was extremely helpful to the parent.”

42. Consultation to Child Care Centers Child Outcomes 90%

43. Consultation to Child Care Centers Relationships with Families 83%

44. Consultation to Parents Outcomes 100%

45. ~ In Their Own Words ~ “I was not sure [my children] needed a mental health person, but I think we all did....HUGS also is now helping me look at what child care should be…so I can keep [my children] safe and smart.”

46. CSEFEL Training

47. CSEFEL Training Positive Feedback 100%

48. ~ In Their Own Words ~ “I have lots of up-and-coming 2 year olds that tantrum out...I plan on using new techniques to calm and make children understand.”

49. CSEFEL Mentoring Outcomes 100%

50. ~ In Their Own Words ~ “I was shown a way to get my kids more involved by having fun along with learning; how to help them to socialize; how to listen to them more.”